Lumbo-Pelvic Region

Back pain can be caused by trauma but frequently it is insidious, recurrent and an ongoing problem for many people. Research has identified a sub-group of people with low back pain that have poor control of movement in the lumbar spine and have deficits in the awareness of their lumbo-pelvic positioning. These people move more at the lumbar spine that at the hips and it is commonly the uncontrolled movements of the spine and pelvis that provoke their pathology and pain.

Treatment is enhanced by understanding the mechanism behind the altered movement pattern. These are discussed and examples demonstrated during the practical sessions. A universal clinical problem solving model is given to iron out real-life difficulties. Normal movement develops during infancy with primitive and postural reflexes. This process will be discussed and examples provided to show how movement patterns can quickly change with primitive reflex inhibition. We will provide participants with easy to use clinical prediction rules to diagnose and rehabilitate low back pain.

This is an evidence based course. Four randomized controlled trials support the use of controlling movement of the lumbar spine.

Course objectives

The participant will be able to:

Be able to assess for movement pattern control deficits in the lumbar spine and pelvis relating to functional movements that provoke the patient’s symptoms

Understand the different mechanisms behind movement pattern control deficits

Appreciate the different causes of restrictions and increased muscle tone

Apply Clinical prediction rules for:

sub-classification to diagnose a movement pattern control deficit

prescription of appropriate rehab strategies.

Show an understanding of the progression of movement pattern control into movement and function using

Mechanisms of Movement Pattern Control Deficits
Treatment is enhanced by understanding the mechanism behind the altered movement pattern. We will provide you with our research and show you how to identify this clinically.

Primitive Reflexes
Primitive reflexes can influence the ability of people to perform these exercises. We will show you how to identify some of these and give you options of how to deal with them.

Psoas Major as a Stabilizer
Psoas major barely flexes the hip! – its main function is to stabilize the lumbar spine, SIJ and hip. Research shows that it has segmental atrophy similar to multifidus and needs specific rehab. We can also use psoas major for pelvic floor rehab!

Gluteus maximus is a multitasking muscle!
It has three functional subdivisions. The Deep Sacral Gluteus Maximus only crosses the sacroiliac joint and is ideally suited for SIJ stability. Why don’t some people progress with glut max training and what can we do about it?

Vertical loading is a direction of load that can cause a control deficit!
During vertical loading, the lumbar spine can move into uncontrolled flexion, extension and /or rotation. We have two validated tests you have not seen before.

Other Rehab Options
Some people do well by going to the gym or doing things like pilates, or going to the gym, but some don’t. We’ll show you how to give people accurate advice and what they can and can’t do.

What about the people who don’t get it?
Some people cannot or have significant difficulty learning specific exercises. We’ll help you screen them and give you alternative rehab options.

Core Stability Explained
There are many interpretations of core stability. Some people do better with strengthening and some do better with gentle and specific exercises. We will explain all the interpretations and show you how it all fits into rehabilitation.